Private Voluntary Health Insurance : Consumer Protection and Prudential Regulation
Health care expenditures can be financed through a mix of public resources and private spending. Private spending is a much larger share of total health spending in low- and middle-income countries than in higher income countries. Moreover, a significant percentage of private spending in those count...
| Main Authors: | , , , , , |
|---|---|
| Format: | Publication |
| Language: | en_US |
| Published: |
Washington, DC: World Bank
2013
|
| Subjects: | |
| Online Access: | http://hdl.handle.net/10986/13093 |
| id |
okr-10986-13093 |
|---|---|
| recordtype |
oai_dc |
| repository_type |
Digital Repository |
| institution_category |
Foreign Institution |
| institution |
Digital Repositories |
| building |
World Bank Open Knowledge Repository |
| collection |
World Bank |
| language |
en_US |
| topic |
access to health care access to health services accident insurance actuaries administrative costs adverse selection Agents ambulance annual financial statements Assurance auditors beneficiaries Capital Requirements capitation capitation payment capitation payments care plans choice of provider clinics coinsurance commissions compensation complementary medicine Consumer Protection consumers contracts with providers cost of health care Cost sharing costs of health care Coverage credit risk delivery of health care dental care economies of scale equitable access to health care expenditures Families fiduciary financial incentive financial incentives Financial Information financial management financial resources financial risk financing health care general insurance health budgets health care health care costs health care expenditures health care financing health care needs health care provider health care providers health care services health care spending health care system health expenditures health financing Health Industry Health Institutions Health Insurance health insurance coverage health insurance fund health insurance industry health insurance market health insurance markets health insurance policies health insurance regulation health insurance scheme health insurance schemes health insurance system Health maintenance Health maintenance organization health maintenance organizations health plans Health Policy health reforms health service health services health spending health status Health Systems HMO HMOs hospitalization hospitals human resources illness income income countries income groups income population Indemnity informal sector information systems inspections insurance activities insurance benefits Insurance brokers insurance buyers insurance claims Insurance Commissioners insurance companies insurance contracts insurance coverage insurance function insurance industries insurance industry insurance law insurance licenses insurance market insurance markets insurance policies insurance premium insurance premium rates insurance premiums insurance products insurance rates insurance regulation insurance risk insurance supervision insurance supervisors insurance systems insurancerisk insurers integrity Intermediaries internal controls intervention investigations laws legal framework level playing field Life Insurance low-income countries managed care managed care plans market failures market forces marketing medical care medical conditions medical expenses medical insurance Medicare moral hazard mutual insurance companies national health National Health Insurance National Health Policy national health services Non-Life Insurance nongovernmental organizations Nutrition patient payments for health care policyholders price competition primary care private health coverage Private Health Insurance private health insurers private hospitals private insurance private insurers Private Sector private spending programs provision of health services public health public health care Public health insurance public health system public insurance public insurer public providers public sector rehabilitation Reinsurance reinsurance companies reinsurers renewals Reserves Risk Factors risk management risk managers smoking social health insurance Solvency Solvency Requirements supervisory agencies supervisory authorities supervisory framework supervisory infrastructure supervisory system surgery underwriting workers workers compensation |
| spellingShingle |
access to health care access to health services accident insurance actuaries administrative costs adverse selection Agents ambulance annual financial statements Assurance auditors beneficiaries Capital Requirements capitation capitation payment capitation payments care plans choice of provider clinics coinsurance commissions compensation complementary medicine Consumer Protection consumers contracts with providers cost of health care Cost sharing costs of health care Coverage credit risk delivery of health care dental care economies of scale equitable access to health care expenditures Families fiduciary financial incentive financial incentives Financial Information financial management financial resources financial risk financing health care general insurance health budgets health care health care costs health care expenditures health care financing health care needs health care provider health care providers health care services health care spending health care system health expenditures health financing Health Industry Health Institutions Health Insurance health insurance coverage health insurance fund health insurance industry health insurance market health insurance markets health insurance policies health insurance regulation health insurance scheme health insurance schemes health insurance system Health maintenance Health maintenance organization health maintenance organizations health plans Health Policy health reforms health service health services health spending health status Health Systems HMO HMOs hospitalization hospitals human resources illness income income countries income groups income population Indemnity informal sector information systems inspections insurance activities insurance benefits Insurance brokers insurance buyers insurance claims Insurance Commissioners insurance companies insurance contracts insurance coverage insurance function insurance industries insurance industry insurance law insurance licenses insurance market insurance markets insurance policies insurance premium insurance premium rates insurance premiums insurance products insurance rates insurance regulation insurance risk insurance supervision insurance supervisors insurance systems insurancerisk insurers integrity Intermediaries internal controls intervention investigations laws legal framework level playing field Life Insurance low-income countries managed care managed care plans market failures market forces marketing medical care medical conditions medical expenses medical insurance Medicare moral hazard mutual insurance companies national health National Health Insurance National Health Policy national health services Non-Life Insurance nongovernmental organizations Nutrition patient payments for health care policyholders price competition primary care private health coverage Private Health Insurance private health insurers private hospitals private insurance private insurers Private Sector private spending programs provision of health services public health public health care Public health insurance public health system public insurance public insurer public providers public sector rehabilitation Reinsurance reinsurance companies reinsurers renewals Reserves Risk Factors risk management risk managers smoking social health insurance Solvency Solvency Requirements supervisory agencies supervisory authorities supervisory framework supervisory infrastructure supervisory system surgery underwriting workers workers compensation Brunner, Greg Gottret, Pablo Hansl, Birgit Kalavakonda, Vijayasekar Nagpal, Somil Tapay, Nicole Private Voluntary Health Insurance : Consumer Protection and Prudential Regulation |
| description |
Health care expenditures can be financed through a mix of public resources and private spending. Private spending is a much larger share of total health spending in low- and middle-income countries than in higher income countries. Moreover, a significant percentage of private spending in those countries is out-of-pocket direct payments for health care services by individuals. Out of pocket expenditures account for more than 60 percent of the total health care spending in low-income countries and 40 percent of total health care spending in middle-income countries. A growing number of low- and middle-income governments are considering private health insurance as a way of both reducing the risk that individuals will have a catastrophic financial burden and achieving other public health care goals. Among these goals are reducing the financial burden on overstretched public health financing, achieving more equitable access to health care, and improving quality and efficiency in the delivery of health care services. An important component of a successful private health insurance market, however, is its legal framework. As discussed in detail later in this book, countries regulate insurance companies to counter systemic market failures that lead to an inefficient and inequitable market. In particular, insurance laws are designed to prevent insurers from becoming insolvent and from engaging in unfair practices and discriminatory behavior. When private health insurance serves as a significant source of financing in a nation's health care system, usually insurance laws also include a range of consumer protection laws that enhance both access to the services covered by private health insurers and the adequacy of the benefits provided by the insurer. This chapter provides a general overview of private health insurance. It begins with a discussion of the definition of private health insurance and the potential roles of private health insurance as part of a nation's health care financing system. In addition, the chapter reviews the variety of entities that sell private health insurance. |
| format |
Publications & Research :: Publication |
| author |
Brunner, Greg Gottret, Pablo Hansl, Birgit Kalavakonda, Vijayasekar Nagpal, Somil Tapay, Nicole |
| author_facet |
Brunner, Greg Gottret, Pablo Hansl, Birgit Kalavakonda, Vijayasekar Nagpal, Somil Tapay, Nicole |
| author_sort |
Brunner, Greg |
| title |
Private Voluntary Health Insurance : Consumer Protection and Prudential Regulation |
| title_short |
Private Voluntary Health Insurance : Consumer Protection and Prudential Regulation |
| title_full |
Private Voluntary Health Insurance : Consumer Protection and Prudential Regulation |
| title_fullStr |
Private Voluntary Health Insurance : Consumer Protection and Prudential Regulation |
| title_full_unstemmed |
Private Voluntary Health Insurance : Consumer Protection and Prudential Regulation |
| title_sort |
private voluntary health insurance : consumer protection and prudential regulation |
| publisher |
Washington, DC: World Bank |
| publishDate |
2013 |
| url |
http://hdl.handle.net/10986/13093 |
| _version_ |
1764422450036080640 |
| spelling |
okr-10986-130932021-04-23T14:03:06Z Private Voluntary Health Insurance : Consumer Protection and Prudential Regulation Brunner, Greg Gottret, Pablo Hansl, Birgit Kalavakonda, Vijayasekar Nagpal, Somil Tapay, Nicole access to health care access to health services accident insurance actuaries administrative costs adverse selection Agents ambulance annual financial statements Assurance auditors beneficiaries Capital Requirements capitation capitation payment capitation payments care plans choice of provider clinics coinsurance commissions compensation complementary medicine Consumer Protection consumers contracts with providers cost of health care Cost sharing costs of health care Coverage credit risk delivery of health care dental care economies of scale equitable access to health care expenditures Families fiduciary financial incentive financial incentives Financial Information financial management financial resources financial risk financing health care general insurance health budgets health care health care costs health care expenditures health care financing health care needs health care provider health care providers health care services health care spending health care system health expenditures health financing Health Industry Health Institutions Health Insurance health insurance coverage health insurance fund health insurance industry health insurance market health insurance markets health insurance policies health insurance regulation health insurance scheme health insurance schemes health insurance system Health maintenance Health maintenance organization health maintenance organizations health plans Health Policy health reforms health service health services health spending health status Health Systems HMO HMOs hospitalization hospitals human resources illness income income countries income groups income population Indemnity informal sector information systems inspections insurance activities insurance benefits Insurance brokers insurance buyers insurance claims Insurance Commissioners insurance companies insurance contracts insurance coverage insurance function insurance industries insurance industry insurance law insurance licenses insurance market insurance markets insurance policies insurance premium insurance premium rates insurance premiums insurance products insurance rates insurance regulation insurance risk insurance supervision insurance supervisors insurance systems insurancerisk insurers integrity Intermediaries internal controls intervention investigations laws legal framework level playing field Life Insurance low-income countries managed care managed care plans market failures market forces marketing medical care medical conditions medical expenses medical insurance Medicare moral hazard mutual insurance companies national health National Health Insurance National Health Policy national health services Non-Life Insurance nongovernmental organizations Nutrition patient payments for health care policyholders price competition primary care private health coverage Private Health Insurance private health insurers private hospitals private insurance private insurers Private Sector private spending programs provision of health services public health public health care Public health insurance public health system public insurance public insurer public providers public sector rehabilitation Reinsurance reinsurance companies reinsurers renewals Reserves Risk Factors risk management risk managers smoking social health insurance Solvency Solvency Requirements supervisory agencies supervisory authorities supervisory framework supervisory infrastructure supervisory system surgery underwriting workers workers compensation Health care expenditures can be financed through a mix of public resources and private spending. Private spending is a much larger share of total health spending in low- and middle-income countries than in higher income countries. Moreover, a significant percentage of private spending in those countries is out-of-pocket direct payments for health care services by individuals. Out of pocket expenditures account for more than 60 percent of the total health care spending in low-income countries and 40 percent of total health care spending in middle-income countries. A growing number of low- and middle-income governments are considering private health insurance as a way of both reducing the risk that individuals will have a catastrophic financial burden and achieving other public health care goals. Among these goals are reducing the financial burden on overstretched public health financing, achieving more equitable access to health care, and improving quality and efficiency in the delivery of health care services. An important component of a successful private health insurance market, however, is its legal framework. As discussed in detail later in this book, countries regulate insurance companies to counter systemic market failures that lead to an inefficient and inequitable market. In particular, insurance laws are designed to prevent insurers from becoming insolvent and from engaging in unfair practices and discriminatory behavior. When private health insurance serves as a significant source of financing in a nation's health care system, usually insurance laws also include a range of consumer protection laws that enhance both access to the services covered by private health insurers and the adequacy of the benefits provided by the insurer. This chapter provides a general overview of private health insurance. It begins with a discussion of the definition of private health insurance and the potential roles of private health insurance as part of a nation's health care financing system. In addition, the chapter reviews the variety of entities that sell private health insurance. 2013-04-09T16:02:05Z 2013-04-09T16:02:05Z 2012-05-14 978-0-8213-8756-6 DOI:10.1596/978-0-8213-8756-6 http://hdl.handle.net/10986/13093 en_US CC BY 3.0 IGO http://creativecommons.org/licenses/by/3.0/igo World Bank Washington, DC: World Bank Publications & Research :: Publication Publications & Research |